Post by B Krishan
Electroencephalogram (EEG)
It is a valuable test for the diagnosis of epilepsy, where the report of an eyewitness is not either totally offered, or is not accessible at all. But, in such cases, a word of caution. The EEG need to be read really carefully, and the guidance of a specialist should be obtained, so that a non-epileptic person may not be labelled as a case of epilepsy, which will be indeed really unfortunate for the patient.
In some cases, where the EEG is negative, and the patient is still strongly suspected to be a case of epilepsy, EEG recordings are completed after showing a flash to the patient (photic stimulation), and/or asking the patient to deeply breath (hyperventilation), or the EEG is recorded when the patient is instructed to be awake the whole night before the test is taken (called sleep-deprivation EEG), as under these circumstances there is a possibility of a positive graph. But once more, a careful analysis of the EEG is necessary by an professional to exclude falsepositive outcomes. In any case, if the EEG is grossly abnormal, risk of repeated attacks of epilepsy ought to be explained both to the patient and his family members members, so that he remains under observation all the time till the attacks are controlled with particular treatment. An EEG is equally essential for the diagnosis of childhood epilepsy.
In selected instances, a 24-hour continuous ambulatory recording of EEG may possibly be taken on the same pattern as the Holter test, completed in heart patients to see the different irregularities in the rhythm of the heart (arrhythmias). In such a continuous record of EEG, the chances of a positive graph improve, as the recording is for a considerable length of time, which increases the chances of detection of any abnormality in the graph. Nonetheless, this test too has got its own limitations.
Hence, the value of clinical diagnosis and the accurate report of an eyewitness really should be emphasized again.
Computed tomographic (CT) scanning
A computed tomographic (CT) scan is, indeed, a valuable, non-invasive test in detecting the causative lesions in circumstances of epilepsy, particularly in circumstances of brain tumours. Besides tumours, the test is also beneficial in diagnosing other causes of epilepsy, like post-traumatic scarring/gliosis or porencephaly, i.e. cavity in the brain, tuberculoma (due to tuberculosis), cysticercosis (due to ingestion of infected pork), or cerebral infarction (due to occlusion/thrombosis of 1 of the vessels of the brain).
However, again a very careful interpretation is needed for reading a CT scan for the diagnosis of a shadow /s, as it has been shown in different studies that following an attack of epilepsy, temporary shadows (disappearing in about 1-3 months) of varying sizes may possibly appear in the brain. But such a diagnosis may not be totally free from danger, as such shadows could be pathological, a lot more so, malignant, and therefore, a close follow-up is essential, and repeated scans could be needed to check if the lesion is lessening, persisting or increasing, so that no time is lost in carrying out life-saving treatment. At the very same time, unnecessary treatment/ panic may possibly be avoided.
Such lesions/shadows may possibly most likely be due to post-epileptic oedema/ swelling of the brain.
However, for a neurologist, such lesions create no dilemma for reaching a precise diagnosis, and, above all, the picture is seen as a whole, i.e., all accounts/aspects of the case are taken into consideration - the clinical manifestation of an attack of epilepsy, age of the patient, EEG report, and follow-up reports.
In a number of hospitals, unique epilepsy clinics are being run where a huge number of instances are seen/followed up weekly / fortnightly and, as a result, with experience, such issues are tackled in a routine manner, but may possibly produce a genuine difficulty, at times, for a general practitioner who may possibly want the urgent opinion of a specialist.
Magnetic resonance imaging (MRI)
This test is much more sensitive than a CT scan, and, as a result, in doubtful instances, it must be carried out, specifically when a CT scan is not contributory, and there is no satisfactory improvement in the condition of the patient, in spite of a potent drug therapy for epilepsy.
Other tests may possibly also be needed, such as the examination of stools for worms, specifically for pork tapeworm (Taenia solium), X-ray of both the calf muscles, below the knee, for the presence of calcified cysts of cysticerci, specifically in locations where the incidence of epilepsy is common as a result of taking infected pork. Worms in the gut, in general, irrespective of the type, may precipitate an attack of epilepsy, specifically among kids.
Needless to say that investigations have a definite role in suspected epilepsy, much more so for the detection of possible lesions and their cure. A lot of of the circumstances of epilepsy are idiopathic, i.e., where no cause is accessible, requiring a long course of drugs, and in a very couple of, even a lifelong maintenance dose may be necessary.
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